Event Registration

Communication Solutions TWO DAY WEEKEND INTENSIVE

8 hours on Saturday, Jan. 12th, 2013 - Wednesday, Dec. 31st, 1969 from 9 AM until 5 PM
at Casa Micanopy Retreat Center
Event Contact: (352) 234-6595
Must register by Friday, Jan. 11th, 2013

 

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Registration Info
Full Name
Email
Event Cost	$200.00
Event Options	-- Please Select -- Sliding Scale - add $25.00Sliding Scale - add $50.00Sliding Scale - add $75.00
Registration Fee:
(Please check) I acknowledge and agree that I am over the age of 18 and I have the legal right to register for this event..

Billing Info
Full Name
Company
Phone Number
Address
Apt, Ste, Etc.
City
State	-- Please Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Credit Card Info
Cards Accepted
Card Type	-- Please Select -- American Express Discover Master Card Visa
Card Number
Expiration (mm/yy)	/
Card Verification Code
Registration Fee:
Comments
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